Sean Kaliski

Phenotypic characterization and genealogical tracing in an Afrikaner schizophrenia database.

Founder populations hold tremendous promise for mapping genes for complex traits, as they offer less genetic and environmental heterogeneity and greater potential for genealogical research. Not all founder populations are equally valuable, however. The Afrikaner population meets several criteria that make it an ideal population for mapping complex traits, including founding by a small number of initial founders that likely allowed for a relatively restricted set of mutations and a large current population size that allows identification of a sufficient number of cases. Here, we examine the potential to conduct genealogical research in this population and present initial results indicating that accurate genealogical tracing for up to 17 generations is feasible. We also examine the clinical similarities of schizophrenia cases diagnosed in South Africa and those diagnosed in other, heterogeneous populations, specifically the US. We find that, with regard to basic sample descriptors and cardinal symptoms of disease, the two populations are equivalent. It is, therefore, likely that results from our genetic study of schizophrenia will be applicable to other populations. Based on the results presented here, the history and current size of the population, as well as our previous analysis addressing the extent of background linkage disequilibrium (LD) in the Afrikaners, we conclude that the Afrikaner population is likely an appropriate founder population to map genes for schizophrenia using both linkage and LD approaches.

Patients with severe mental illness: a new approach to testing for HIV.

BACKGROUND The prevalence of HIV infection in South Africa is approaching 20% of young adults. In severely mentally ill people it is probably higher. Testing for infection is subject to stringent ethical principles. Undiagnosed HIV infection in people with severe mental illness increases costs and morbidity. Since effective treatments are available, it is imperative to diagnose HIV infection early in this high-risk population. METHODS A literature review established the prevalence of HIV infection in inpatient populations with HIV infection. The pattern of testing for HIV over 3 years at a major psychiatric hospital was investigated. We surveyed public sector psychiatrists in the Western Cape to establish their attitudes to HIV in their patients. RESULTS The reported HIV seroprevalence in psychiatric inpatients ranges from 0 to 59.3%, with a mean of 10%. Data show a clear trend towards an increase in prevalence: before 1996 the mean HIV seroprevalence was 7.4%, while after 1996 the mean was 15%. State psychiatrists in the Western Cape do not test routinely for HIV infection, mainly owing to ethical constraints: 14.6% of patients at Lentegeur Hospital were tested in 2006. CONCLUSIONS The high prevalence of HIV infection in South Africa, which is probably higher in patients with severe mental illness (most of whom are not competent to provide informed consent), and the availability of effective treatment require debate and a clear policy regarding testing for HIV infection to be implemented. We recommend a new approach to HIV testing in these patients.

Offenders with Mental Disorder on Five Continents: A Comparison of Approaches to Treatment and Demographic Factors Relevant to Measurement of Outcome

Specialist forensic mental health service development continues worldwide. Given their generally small size and slow patient turnover, aggregating multi-site data could aid in the study of their effectiveness, safety, and value for money. The study compares such context of care and treatment philosophies in nine countries. National databases on demographics, mental disorders, and offending were identified. Participating forensic mental health practitioners independently rated likely outcomes for standard cases of serious offenders with psychosis or personality disorder. Gender distribution was similar between populations, but there were differences in age distribution and proportions of ethnic groups. Rates of psychosis were similar, but there were considerable population-based differences in substance misuse disorder rates, other substance misuse indicators and in criminal conviction statistics. Case analysis confirmed shared preferences for mental health disposals for people with psychosis, and penal disposals otherwise, with differences only in process details. Criminal recidivism was thus found to be a poor comparative measure between these countries, as it was impossible to adjust fully for differences in crime classification and measurement. Clinical outcome measures may be less vulnerable to national differences, but prevalence and type of substance misuse must be rated precisely when sharing or comparing service outcome data between nations.

Mental health and the law: a South African perspective

Mental health law in South Africa has been dominated in recent times by the Mental Health Care Act 2002. This paper provides selective insights into specific aspects of that Act and highlights its impact on clinical practice within a broad clinical setting and in so doing suggests areas for review and revision.

Attack on psychoanalysis

Critique of the editors attack on psychoanalysis in the editorial MY BRAIN MADE ME DO IT, SAJP March 2009, Vol. 15, No 1